Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study

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Aljofi" }, { "@type": "Person", "name": "Mishali AlSharief" }, { "@type": "Person", "name": "Manal AlSaadoun" }, { "@type": "Person", "name": "Yasser S. Alali" }, { "@type": "Person", "name": "Yousif A. Al-Dulaijan" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Third molar extraction is one of the most common oral surgical procedures globally. This study assessed patients’ knowledge of third molar extraction procedures. Methods A self-administered questionnaire was administered to patients (N=384) of the dental hospital at Imam Abdulrahman bin Faisal University in the eastern province. The questionnaire covered demographic data, knowledge of third molar extraction, and patients’ perception questions. SPSS Version 24 was used for statistical analysis. Chi-square and Fisher’s Exact test were used. P-values less than or equal to 0.05 were considered statistically significant. Results According to the demographical characteristics of the patient who received 3rd molar removal surgery. As per the history of the extraction, 45% had previous 3rd molar extraction experience, whereas 55% had no previous dental surgical experience. There was no significant difference between the groups with the knowledge about the extraction (p-0.187). Patients with no previous history were more aware of the correct time for 3rd molar extraction at 27% vs 19%, respectively (P=0.046*). Patients with a previous history of third molar extraction showed significant results of knowledge in terms of taking medication prior to 3rd molar surgical procedure. Conclusion The patient with previous experience with third molar extraction showed low misconceptions. However, further studies should consider increasing the knowledge and correcting the patients’ perceptions. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-1376", "name": "Evaluation of Pre-Extraction Knowledge and Perception of the Third..." } } ] } Home Browse Evaluation of Pre-Extraction Knowledge and Perception of the Third... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Alshehri S, Alshehri T, AlMutiri H et al. Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.12688/f1000research.158144.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] Previously titled: Evaluation of Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study Sami Alshehri https://orcid.org/0000-0003-0155-5035 1 , Turki Alshehri https://orcid.org/0000-0001-7575-1587 2 , Hadeel AlMutiri 3 , [...] Abdulla Aljami https://orcid.org/0000-0002-7784-9104 3 , Ahmed Alsubaie 1 , Faisal E. Aljofi https://orcid.org/0000-0002-1652-5325 4 , Mishali AlSharief 4 , Manal AlSaadoun 5 , Yasser S. Alali 6 , Yousif A. Al-Dulaijan https://orcid.org/0000-0002-8180-8903 2 Sami Alshehri https://orcid.org/0000-0003-0155-5035 1 , Turki Alshehri https://orcid.org/0000-0001-7575-1587 2 , [...] Hadeel AlMutiri 3 , Abdulla Aljami https://orcid.org/0000-0002-7784-9104 3 , Ahmed Alsubaie 1 , Faisal E. Aljofi https://orcid.org/0000-0002-1652-5325 4 , Mishali AlSharief 4 , Manal AlSaadoun 5 , Yasser S. Alali 6 , Yousif A. Al-Dulaijan https://orcid.org/0000-0002-8180-8903 2 PUBLISHED 11 Nov 2025 Author details Author details 1 Department of Biomedical Dental Sciences, college of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 2 Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 3 College of dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 4 Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 5 Dental Department, Imam Abdulrahman Al Faisal Hospital, Dammam, Eastern Province, Saudi Arabia 6 Department of Oral and Maxillofacial Surgery, RGSA3094, King Saud University,, King Saud University, Riyadh. Building 44, 1st Floor. Office #250, Saudi Arabia Sami Alshehri Roles: Investigation, Methodology, Project Administration, Supervision Turki Alshehri Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation Hadeel AlMutiri Roles: Data Curation, Methodology, Writing – Original Draft Preparation Abdulla Aljami Roles: Data Curation, Visualization, Writing – Original Draft Preparation Ahmed Alsubaie Roles: Funding Acquisition, Investigation, Methodology, Validation Faisal E. Aljofi Roles: Methodology, Validation, Visualization, Writing – Review & Editing Mishali AlSharief Roles: Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Manal AlSaadoun Roles: Formal Analysis, Software, Validation, Writing – Review & Editing Yasser S. Alali Roles: Funding Acquisition, Investigation, Project Administration, Supervision, Writing – Review & Editing Yousif A. Al-Dulaijan Roles: Methodology, Project Administration, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Third molar extraction is one of the most common oral surgical procedures globally. This study assessed patients’ knowledge of third molar extraction procedures. Methods A self-administered questionnaire was administered to patients (N=384) of the dental hospital at Imam Abdulrahman bin Faisal University in the eastern province. The questionnaire covered demographic data, knowledge of third molar extraction, and patients’ perception questions. SPSS Version 24 was used for statistical analysis. Chi-square and Fisher’s Exact test were used. P-values less than or equal to 0.05 were considered statistically significant . Results According to the demographical characteristics of the patient who received 3rd molar removal surgery. As per the history of the extraction, 45% had previous 3rd molar extraction experience, whereas 55% had no previous dental surgical experience. There was no significant difference between the groups with the knowledge about the extraction (p-0.187). Patients with no previous history were more aware of the correct time for 3rd molar extraction at 27% vs 19%, respectively (P=0.046*). Patients with a previous history of third molar extraction showed significant results of knowledge in terms of taking medication prior to 3rd molar surgical procedure. Conclusion The patient with previous experience with third molar extraction showed low misconceptions. However, further studies should consider increasing the knowledge and correcting the patients’ perceptions. READ ALL READ LESS Keywords Extraction, wisdom teeth, difficulty indices, postoperative pain, third molar Corresponding Author(s) Turki Alshehri ( [email protected] ) Close Corresponding author: Turki Alshehri Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Alshehri S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Alshehri S, Alshehri T, AlMutiri H et al. Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.12688/f1000research.158144.2 ) First published: 18 Nov 2024, 13 :1376 ( https://doi.org/10.12688/f1000research.158144.1 ) Latest published: 11 Nov 2025, 13 :1376 ( https://doi.org/10.12688/f1000research.158144.2 ) Revised Amendments from Version 1 The new version includes modified title. Introduction: correcting a detailed reference in the introduction as well as the new modified rational for the study. Methodology: more details about sample size calculation provided. Timetable for the start and the end of the study Conclusion: modifying new conclusion based on the result of the study The new version includes modified title. Introduction: correcting a detailed reference in the introduction as well as the new modified rational for the study. Methodology: more details about sample size calculation provided. Timetable for the start and the end of the study Conclusion: modifying new conclusion based on the result of the study See the authors' detailed response to the review by Ahmed Fadhel Al-Quisi READ REVIEWER RESPONSES Introduction Third molar extraction is one of the most frequently performed oral surgical procedures worldwide. 1 Tooth impaction is defined as the inability of the tooth to erupt in a full functional position in the oral cavity. 2 Clinical and radiographical evaluations could predict the degree of difficulty of third molar extraction preoperatively. 3 The patient’s advanced age, depth, angulation of the impaction, and proximity to the inferior alveolar canal, maxillary sinus, and infratemporal fossa contribute to the extraction difficulty. 4 Multiple theories elucidated the rationale behind third molar impactions: the discrepancy between the dental arch circumference and the sum of the mesiodistal width of the teeth, the attrition theory, and the discrepancy between dental and skeletal maturation. 5 The eruption of third molars usually begins at the age of 17 to approximately 21 years. 5 However, it is estimated that third molars fail to erupt in 25% of the population. 6 Third molars are indicated for extraction if they include one or more of the following: developmental cysts, infections, recurrent episodes of pericoronitis, a periodontal disease affecting the adjacent teeth, interfering with adjacent teeth eruption, non-restorable or pulpal involvement, and for orthodontic or orthognathic considerations. 7 There are some factors to be taken into consideration during decision-making for third molar extraction, such as the tooth position, proximity to vital structures, limited mouth opening, ankylosis, history of radiation therapy, medications such as a bisphosphonate, as well as overall patient health. 8 In wisdom tooth extraction, According to Seymour et al., post-operative discomfort, pain, swelling, and bleeding are commonly associated with the procedure. 9 A post-operative symptoms severity (PoSSe) scale was developed to measure the discomfort and severity of symptoms following third molar extraction, and it was shown that 97% of patients suffered from post-operative pain. 10 Operative factors have little bearing on patients’ quality of life (QOL). 11 In aiming to improve the patient’s experience, multiple studies investigated the effect of medications on pain management studies). Monaco G. et al. concluded that antibiotic prophylaxis effectively prevented wound infection and postoperative pain in young patients after removing lower third molars. 6 Another study reported that Cryotherapy effectively decreased postoperative swelling, pain, and limitation of mouth opening, improving patients’ QOL. 12 An additional study showed a high association between patients’ anxiety and post-operative pain. Patient awareness of the procedure could minimize anxiety about wisdom teeth extraction. 13 The author suggested conducting a separate consultation with an Oral and Maxillo-Facial Surgeon (OMFS) to make the procedure more comprehensible to the patient. On the other hand, other studies reported that separate wisdom teeth consultation did not reduce the level of anxiety. 14 However, adequate awareness about the procedure is required for all patients, especially anxious patients. 15 It has been shown that patients with more inquiries are more anxious than others, and women are more anxious than men. 16 Overall, the true perception of patients about the preoperative, intraoperative, and postoperative nature of wisdom teeth extraction could positively impact their experience with wisdom teeth extraction. 17 The clinician must know that all patients require sufficient information regarding the procedure. It’s essential to guide surgeons to optimize the surgical procedure, increase patient comfort, and decrease postoperative risks. 18 Brasileiro B. et al. evaluated patients’ perceptions at different stages of third molar extraction and highlighted notable preoperative concerns regarding the procedure. 11 Comparing patients with previous extraction experience and those without experience, patients with no experience had more questions and misconceptions than the ones with prior experience. 18 Although several studies have examined patients’ perceptions toward third molar extraction in different countries, limited research has focused on the preoperative perceptions of patients in Saudi Arabia. Cultural and social factors in the Eastern Province may influence patients’ understanding, attitudes, and concerns toward this procedure. Therefore, this study aims to address this gap by evaluating preoperative knowledge and perception among this specific population. Methods Study design and setting A cross-sectional observational study based on patients’ knowledge and perception regarding third molar extraction was conducted on patients seen at the Dental Hospital at Imam Abdulrahman bin Faisal University in the Eastern province of Saudi Arabia. Study participants A self-administered questionnaire has been distributed and collected from patients registered at the Dental Hospital of Imam Abdulrahman bin Faisal University who attended for treatment. Patients with mental illness, disability, inability to write and read, or individuals aged less than 18 years who a legal guardian did not accompany were excluded from this study. Ethical approval obtained on October 22, 2022. Data collection was carried out over the following months, followed by data analysis and manuscript preparation until the end of January 12, 2024. Sample size and sampling technique The minimum required sample size for this study was calculated using the standard formula for estimating proportions, assuming a 95% confidence level (Z = 1.96), 5% margin of error (d = 0.05), and a conservative estimated proportion (p = 0.50) to maximize population variability. This yielded a required sample size of 384 participants. To ensure adequate representation and account for possible refusals or incomplete responses, the questionnaire was distributed to 420 potential participants, allowing sufficient coverage of the calculated sample requirement. Data collection tool A self-administered validated questionnaire has been distributed and consists of two parts. The first part includes patients’ demographic information (age, gender, education level, history of third molar extraction). The second part is divided into two categories; the first is knowledge of third molar extraction, eruption, causes for extraction, mandatory of third molar extraction, multiple extractions at the same visit, anesthesia technique, dental phobia, and relationship between smoking and healing process. The second part is patients’ perception questions, which include anxiety relief during the surgical procedure, similarities in the extraction of the third molar to other molars, pre-operative and post-operative medications, and difficulty of third molar extraction teeth alignment after third molar extraction. The questionnaire was calibrated as a pilot study on 30 patients. Statistical analysis Data was initially recorded in Excel and then transferred to SPSS (Version 24, IBM, Armonk, NY) for further analysis. Where appropriate, descriptive statistics were calculated using frequency, percentages, mean, and standard deviations. The Chi-square/Fisher’s Exact test was used where appropriate for inferential statistics. Knowledge items were coded as 0=for misconception and 1=for correct answer. Multivariate logistic regression was used to evaluate the probable association with knowledge from patients with previous experience. P-values less than or equal to 0.05 were statistically significant. Results In total, 409 patients had third molar extractions, of which 266 (65%) were male and 35% were female. Most patients were Saudi nationals (89%), and 46% were between 18 and 24 years old. Table 1 shows the demographic characteristics of the patients who had third molar removal surgery. As per history with the extraction, 45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise. Table 1. Demographical characteristics of patients. Demographical variable Frequency Percentages Age 18-24 189 46 25-34 87 21 35-44 75 18 45 and more 58 14 Gender Male 266 65 Female 143 35 Saudi Saudi 364 89 Non-Saudi 45 11 Education School 149 36 College 255 62 None 5 1 Status Employment Public 87 21 Private 83 20 Business 7 2 None 232 57 History Yes 186 45 No 223 55 In this study, the most common indication for wisdom teeth extraction was the abnormal path of tooth eruption (24%), followed by pain or decayed teeth (19%). Figure 1 summarizes all other indications of wisdom teeth extraction. Patients were divided into two groups: previous experience with the extraction and no previous extraction, and a comparison was done with knowledge items. Quantitatively, no significant difference was found between the groups with knowledge about the extraction (p-0.901). A qualitative comparison is presented in Table 2 . Patients with no previous history were found to be more aware of the correct time for third molar eruption, 27%, vs. patients with a previous history of extraction, 19%, and the association was also statistically significant (p-0.046). Correct knowledge level about items, extraction of the third molar is mandatory (67% vs. 73%), a phobia about pain and actual pain feeling (54% vs. 51%), and smoking after the extraction delayed the healing process (49% vs 50%) was almost same between both groups without any statistical significance. Additionally, the misconception about anesthetic technique and extraction of more than 1 extraction was found to be highest in both groups with no statistically significant difference. Figure 1. Indications for wisdom teeth extraction in this study. Table 2. Comparison of knowledge about wisdom teeth extraction based on previous experience of extraction. Knowledge items Participants without previous extraction history n=223 Participants with previous extraction history n=186 p-value What age does wisdom teeth erupt? Correct 26.9% 19.4% 0.046 * Misconception 73.1% 80.6% Does everyone have to extract their wisdom teeth Correct 68.6% 73.1% 0.187 Misconception 31.4% 26.9% Is it possible to do an extraction for all wisdom teeth at the same visit? Correct 14.3% 16.1% 0.358 Misconception 85.7% 83.9% Do you think the anesthetic technique for wisdom teeth similar to other molars? Correct 35.9% 41.4% 0.149 Misconception 64.1% 58.6% Do you think there is a relationship between dental phobia/anxiety and feeling pain during surgical procedure? Correct 54.3% 50.5% 0.257 Misconception 45.7% 49.5% Do you think smoking after the extraction of wisdom teeth will affect the healing process for extraction area? Correct 48.9% 50.0% 0.45 Misconception 51.1% 50.0% * Significant at 0.05. Table 3 presents the patients’ perceptions with and without previous experience with extraction. Crowded teeth can be aligned by extraction; Group 2 (previous experience) was more confident than Group 1 (no experience) (42% vs. 37% respectively) but not significantly different. Regarding the medication before the surgery, group 2 was statistically higher with the right perception (47% vs. 25%) (p-0.001). Other perceptions were not statistically different between groups 1 and 2. Analgesics were the most common choice among the other medications mentioned (34%) for post-operative medicines Figure 2 . The majority (43%) thought all mentioned medication should be taken after the surgery. Table 3. Comparison of patients’ perceptions about the tooth extraction based on the previous extraction experience. Perception items Participants without previous extraction history n=223 Participants with previous extraction history n=186 p-value Do you think extraction of wisdom teeth will aid in the alignment of crowded teeth? Yes 37.2% 41.9% 0.053 No 14.3% 18.3% Maybe 33.6% 21.5% I have no idea 14.8% 18.3% Do you think you should take any medications before starting the procedure Antibiotics 6.3% 12.9% 0.001 * Analgesic 22.4% 15.1% No 25.1% 47.3% I have no idea 46.2% 24.7% Does anxiety relieve when the doctor explains all steps of the surgical procedure to extract third molar? Yes 52.5% 64.5% 0.06 No 8.1% 8.6% Maybe 33.2% 23.1% I have no idea 6.3% 3.8% do you think the extraction of wisdom teeth similar to another molar Yes 14.3% 18.3% 0.153 No 49.8% 55.4% Maybe 22.9% 18.8% I have no idea 13.0% 7.5% Do you think wisdom teeth extraction is a complicated procedure? Yes 26.0% 23.7% 0.071 No 30.0% 38.7% Maybe 32.3% 32.3% I have no idea 11.7% 5.4% * Significant at 0.05. Figure 2. Patients knowledge about the post-operative medication in this study. Multiple logistic regression showed no statistically significant factors associated with the knowledge level Table 4 . The chance of correct knowledge about the eruption time was 1.489 times higher among patients with previous experience. Similarly, those who have prior experience know better (OR = 1.230) about the pain and anxiety relationship during the surgery. For the rest of the items, the knowledge was not as expected from the experienced group. Table 4. Logistics Regression shows the association of knowledge items with patients' previous experience of extracted teeth. Knowledge items OR Lower limit Upper limit P-value What age does wisdom teeth erupt? Correct 1.489 0.928 2.388 0.099 Misconception 1 - - Does everyone have to extract their wisdom teeth Correct 0.790 0.505 1.236 0.301 Misconception 1 - - Is it possible to do an extraction for all wisdom teeth at the same visit? Correct 0.917 0.528 1.592 0.757 Misconception 1 - - Do you think the anesthetic technique for wisdom teeth similar to other molars? Correct 0.794 0.526 1.199 0.273 Misconception 1 - - Do you think there is a relationship between dental phobia/anxiety and feeling pain during surgical procedure? Correct 1.230 0.815 1.858 0.325 Misconception 1 - - Do you think smoking after the extraction of wisdom teeth will affect the healing process for extraction area? Correct 0.980 0.647 1.485 0.923 Misconception 1 - - Discussion The present study aimed to investigate the knowledge and misconceptions of patients about third molar extraction. Out of 409 total responses, 65% of those who attended the dental hospital seeking different dental treatments were males. Compared to females, a study showed that males attended more dental clinics for third molar extraction. 19 However, a study reported a higher female-to-male ratio regarding third molar extraction. 20 This kind of discrepancy in demographic factors can be found in many studies. However, regarding the third molar extraction procedure, a systematic review study highlighted females presented with 14% more than males in terms of having at least one missing third molar. 21 In our study, the age group between 18 and 24 years was predominant among the participants. Generally, this is the eruption time of third molars. 22 A previous study showed that patients undergoing third molar extraction were noted in the age group of 21 to 30 years. 23 Abnormal eruption in the current study was the most common chosen factor, which indicated third molar extraction at 24%, followed by caries and pain at 19%. Additionally, a result revealed by a local study in Saudi Arabia which investigated the prevalence of impaction and the reasons for extraction found that the most common indication for extraction of the third molar was the asymptomatic and prophylactic reason (66.8%), and the symptomatic was (33.2%). 24 In contrast to our findings, Dhafar et al. reported that the caries of third molars was the first indication(42.3%), followed by the eruption abnormalities and prophylactic reason (39.2%). 25 This comes in agreement with another study by Adeyemo et al. on caries factor. 26 However, many factors and reasons can lead to third molar extraction, as discussed previously by Steed MB et al. 27 Our findings compared the misconceptions of patients with and without a previous history of third molar extraction, which resulted in more correct answers from participants in the group with previous extraction history. This agrees with a previous study that evaluated the pre-operative perceptions of patients who underwent third molar extraction and found low misconception among groups with a previous history of third molar extraction. 11 Patients with and without a previous history of third molar extraction showed no significant difference in knowledge. Both groups presented high percentages of correct answers about the third molar age eruption. Moreover, it was mentioned in the previous study that eruption starts at 17 years old in the oral cavity 28 regarding whether extraction of the third molar is mandatory; for this answer, as reported, the decision will be according to the presence of disease and if the tooth asymptomatic or not. 29 Our study showed a misconception about whether it is doable to extract the four wisdoms simultaneously; this can be done locally or under general anesthesia according to the case difficulties. Many variables can be addressed to evaluate the case, either patient-related or third molar-related. 3 Misconceptions regarding the anesthesia technique were noticed in the current study. Generally, the same technique can be used to extract other molars besides different techniques. 30 , 31 There was no significant difference (p-0.325) between the groups when it came to relationship between feeling pain and anxiety/phobia. Additionally, anxiety was reported to be presented with more pain to the patient. 32 However, another study evaluated separate consultation appointments prior to third molar extraction as it was effective according to the patients. 33 Besides that, his relationship was also found in another study in which they reported a significant relationship between less post-operative pain and verbal information about the extraction steps. 34 We believe different ways to reduce anxiety should be considered before third molar extraction. For example, a significant reduction in anxiety levels was reported after using the audiovisual method. 35 Participants showed no statistical significance in both groups regarding whether smoking after extraction delayed the healing process (49% vs 50%). Such answers give us an overview of the lack of knowledge about this fact. In addition, oral hygiene should be maintained after oral surgery to avoid any source of infection and promote healing. Furthermore, a review study reported that tobacco can affect the surgical site after tooth extraction. 36 The knowledge of patients about post-operative medications in our study illustrated that all three analgesics, antibiotics, and mouthwashes should be taken after the third molar extraction (43%); patients answered analgesics only (34%), followed by antibiotics (15%), then mouthwashes (8%). It was reported that analgesics are the most effective medications for pain relief after dental extraction. 37 The role of the antibiotic in oral surgery to prevent post-operative infection was statistically significance, 38 but it is not required for simple extraction. 39 As per our knowledge no previous study was conducted in Saudi Arabia similar to our study. However, some limitations can be addressed in our study, such as the fact that the participants were only from one dental hospital in the eastern province of Saudi Arabia, convenience sample, the study design and patients are not aware of their correct answers after filling out the survey. Thus, further investigation should be done to increase the patients’ knowledge and awareness regarding perioperative and postoperative third molar extraction. We recommend further research to evaluate the pre- and post-knowledge scores and use educational material to assess the improvement level. Conclusions The most common indication for extraction was the abnormal path of tooth eruption, followed by pain or tooth decay. Comparison between patients with and without previous extraction experience revealed generally similar levels of knowledge and perception regarding third molar extraction. However, patients with prior experience demonstrated better understanding of preoperative medication, whereas those without prior experience showed greater awareness of the correct timing of third molar eruption. Misconceptions related to anesthesia and the number of teeth extracted remained common in both groups. Overall, the findings highlight the need for improved patient education on procedural and medication aspects of third molar extraction to enhance understanding and reduce misconceptions. Ethics and consent The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Imam Abdulrahman Bin Faisal University (IRB-2022-02-397) (approval date: 20 th of October, 2022). Written informed consent was obtained from all participants included in the current study. Data availability statement Underlying data Figshare. Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study, https://doi.org/10.6084/m9.figshare.27303840 . 40 This project contains the following underlying data: • Third molar extraction data sheet 3.xlsx. Data for patients participated to fill questionnaire that evaluate the knowledge and perceptions regarding third molar extraction. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare. Questionnaire regarding knowledge of third molar extraction, https://doi.org/10.6084/m9.figshare.27614073 . 41 This project contains the following extended data: • Questionnaire regarding knowledge of third molar extraction.docx. Questionnaire consist of 2 parts, first part: questions regarding the demographic data and previous history of third molar extraction, second part: questions about the knowledge of participants regarding third molar extraction. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Ali A, Benton J, Yates J: Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars—a comparison of two techniques and review of the literature. J. Oral Rehabil. 2018; 45 : 250–257. PubMed Abstract | Publisher Full Text 2. Janakiraman EN, Alexander M, Sanjay P: Prospective analysis of frequency and contributing factors of nerve injuries following third-molar surgery. 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Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 18 Nov 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Biomedical Dental Sciences, college of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 2 Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 3 College of dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 4 Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 5 Dental Department, Imam Abdulrahman Al Faisal Hospital, Dammam, Eastern Province, Saudi Arabia 6 Department of Oral and Maxillofacial Surgery, RGSA3094, King Saud University,, King Saud University, Riyadh. Building 44, 1st Floor. Office #250, Saudi Arabia Sami Alshehri Roles: Investigation, Methodology, Project Administration, Supervision Turki Alshehri Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation Hadeel AlMutiri Roles: Data Curation, Methodology, Writing – Original Draft Preparation Abdulla Aljami Roles: Data Curation, Visualization, Writing – Original Draft Preparation Ahmed Alsubaie Roles: Funding Acquisition, Investigation, Methodology, Validation Faisal E. Aljofi Roles: Methodology, Validation, Visualization, Writing – Review & Editing Mishali AlSharief Roles: Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Manal AlSaadoun Roles: Formal Analysis, Software, Validation, Writing – Review & Editing Yasser S. Alali Roles: Funding Acquisition, Investigation, Project Administration, Supervision, Writing – Review & Editing Yousif A. Al-Dulaijan Roles: Methodology, Project Administration, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 11 Nov 2025, 13:1376 https://doi.org/10.12688/f1000research.158144.2 version 1 Published: 18 Nov 2024, 13:1376 https://doi.org/10.12688/f1000research.158144.1 Copyright © 2025 Alshehri S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Alshehri S, Alshehri T, AlMutiri H et al. Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.12688/f1000research.158144.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 11 Nov 2025 Revised Views 0 Cite How to cite this report: Leonan-Silva B. Reviewer Report For: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.5256/f1000research.191114.r434493 ) The direct URL for this report is: https://f1000research.com/articles/13-1376/v2#referee-response-434493 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Nov 2025 Brender Leonan-Silva , Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.191114.r434493 Dear Authors, Thank you for the opportunity to review this manuscript. After a detailed evaluation of all sections (Abstract, Introduction, Methods, Results, Discussion, and Conclusion), I regret to note that the study presents substantial methodological, structural, ... Continue reading READ ALL Dear Authors, Thank you for the opportunity to review this manuscript. After a detailed evaluation of all sections (Abstract, Introduction, Methods, Results, Discussion, and Conclusion), I regret to note that the study presents substantial methodological, structural, and conceptual limitations that significantly compromise its scientific clarity and validity. Below is a consolidated and detailed report outlining the key issues and recommendations. 1. Major Issues Across the Entire Manuscript 1.1. Lack of a Clear and Coherent Study Objective Throughout the manuscript, the objective remains vague and inconsistently stated. The abstract claims the study is evaluating “knowledge” of third molar extraction. The introduction suggests the aim is to evaluate “preoperative knowledge and perception.” However, the statistical approach and group comparisons indicate the actual aim was likely: “to determine whether previous experience with third molar extraction influences patient knowledge and perceptions.” This objective is never clearly articulated. Recommendation: Rewrite the objective to explicitly match the study design and statistical analysis. 1.2. Severe Inconsistency in Terminology The manuscript alternates between “third molar extraction” and “wisdom tooth extraction” without rationale or consistency. Recommendation: Choose one term and use it consistently throughout the manuscript, tables, and figures. 2. Abstract – Major Structural and Conceptual Problems The abstract lacks a clear objective. The methodology description is vague and incomplete. The results paragraph is grammatically incorrect and difficult to understand. The conclusion is ambiguous and unsupported by the results. Recommendation: Rewrite the abstract entirely to clearly present: Objective Methods (design, participants, outcome variables) Main results Conclusion aligned with the findings 3. Introduction – Problems with Logic, Flow, and Relevance The introduction: Presents excessive background unrelated to knowledge/perception (e.g., surgical difficulty, indications, postoperative pain, QOL studies). Contains paragraphs that do not link to the study’s aim. Does not introduce the constructs being evaluated (knowledge or perception). Does not provide rationale for comparing “previous experience vs. no previous experience.” Recommendation: Rebuild the introduction to: Define knowledge/perception in this context. Present relevant literature on patient awareness regarding third molar procedures. Justify why prior extraction experience might impact knowledge. End with a clear, specific objective. 4. Methods – Major Methodological Weaknesses 4.1. Study Population Ambiguity The sample includes all patients attending the dental hospital for “different dental treatments,” not preoperative third molar patients. This undermines the whole premise of assessing “preoperative” knowledge. 4.2. Sampling Strategy The sample size calculation is inappropriate. A formula for estimating a proportion was used, but the analysis compares two groups. 4.3. Questionnaire Validation The questionnaire is claimed to be “validated” but: No source is given. No psychometric data is reported. No reliability metrics (Cronbach’s alpha). A pilot with 30 patients is not validation. 4.4. Variable Definition “Knowledge” and “perception” constructs are not defined conceptually. All items are simply treated as binary correct/incorrect, which oversimplifies complex constructs. 4.5. Statistical Analysis Issues Logistic regression appears unadjusted (despite collecting age, sex, education). No justification for dichotomization of items. No composite scores. No mention of model diagnostics or assumptions. 5. Results – Numerous Structural and Analytical Problems 5.1. Missing clarity on sample The results start with “409 patients had third molar extractions,” but the Methods say patients were attending “for different treatments.” Inconsistency in sample definition. 5.2. Tables are incomplete and poorly formatted Table 1 has truncated categories. Table 2 presents isolated percentages without meaningful interpretation. Table 3 shows perception questions with unclear scoring logic. 5.3. Figures contain no captions explaining content or methods 5.4. Interpretation Misalignment The results do not justify the emphasis placed in the Discussion. Most findings show no statistically significant differences, but are presented as clinically meaningful. 6. Discussion – Conceptually Weak and Poorly Connected to Results The discussion over-relies on citations unrelated to the study's main variables. It restates background literature instead of critically interpreting results. Many cited findings do not logically relate to the observed results. The claimed “agreement” with prior studies is overstated given weak and mostly non-significant results. The discussion fails to address the possibility that the questionnaire may not have measured the intended constructs. 7. Conclusion – Not Supported by the Data The conclusion states that: “Patients with previous experience demonstrated better understanding…” However: Most comparisons were not statistically significant. The findings were minimal and inconsistent. The conclusion overstates the results. 8. Additional Issues English grammar requires extensive revision throughout the manuscript. Figures appear low quality and lack methodological explanations. The demographic table does not include total sample numbers or proper formatting. The manuscript lacks coherence in structure, terminology, and argumentation. Overall Recommendation: Major Revision Required In its current form, the manuscript requires substantial restructuring before it can be considered for publication. Key required actions: Rewrite the abstract, introduction, and objective. Clarify and fix methodological inconsistencies. Rebuild the Results section with proper formatting and coherent interpretation. Rework the discussion to reflect the study’s actual findings. Ensure consistent terminology and grammar throughout. Provide transparent details about questionnaire development and validation. Consider whether the study design appropriately matches the stated aim — and revise accordingly. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: EpidemiologySystematic Reviews and Meta-analysesEvidence Synthesis (Scoping Reviews, Narrative Reviews)Clinical Trials (randomized, non-randomized, split-mouth, crossover, non-inferiority)Observational Study Designs (cross-sectional, cohort, case-control)Interventional StudiesPeriodontologyTemporomandibular Disorders (TMD)BruxismOrofacial PainDental Public Health I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Leonan-Silva B. Reviewer Report For: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.5256/f1000research.191114.r434493 ) The direct URL for this report is: https://f1000research.com/articles/13-1376/v2#referee-response-434493 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 18 Nov 2024 Views 0 Cite How to cite this report: Al-Quisi AF. Reviewer Report For: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.5256/f1000research.173698.r350574 ) The direct URL for this report is: https://f1000research.com/articles/13-1376/v1#referee-response-350574 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Jan 2025 Ahmed Fadhel Al-Quisi , Oral and Maxillofacial Surgery, University of Baghdad, Baghdad, Baghdad Governorate, Iraq Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.173698.r350574 In scientific writing, terms like "us," "our," and "we" are considered first-person pronouns and should be avoided in scientific writing 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for ... Continue reading READ ALL In scientific writing, terms like "us," "our," and "we" are considered first-person pronouns and should be avoided in scientific writing 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discuss only preoperative perception. try to focus in the introduction about the value of prevoius studies and Avoid dedicating too much space to a single study 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. 4- more detailed information regarding the sample size estimation 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility 6- the time table for the study should be mentioned 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specifiy what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery ? 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? 9- the conclusions should be re-written according to the statisitcal results of the study Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Oral and Maxillofacial Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Al-Quisi AF. Reviewer Report For: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.5256/f1000research.173698.r350574 ) The direct URL for this report is: https://f1000research.com/articles/13-1376/v1#referee-response-350574 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 24 Nov 2025 Turki Alshehri , Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 24 Nov 2025 Author Response We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this ... Continue reading We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") Response: thank you for your time and comments, title adjusted to be: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discusses only preoperative perception. try to focus on the introduction about the value of previous studies and avoid dedicating too much space to a single study Response: thank you for your time and comments Please find the following changes as we removed the extra details and further unnecessary information: Brasileiro B. et al. evaluated patients’ perceptions at different stages of third molar extraction and highlighted notable preoperative concerns regarding the procedure. 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. Response: thank you for your time and comments Please find the following modified rational: Although several studies have examined patients’ perceptions toward third molar extraction in different countries, limited research has focused on the preoperative perceptions of patients in Saudi Arabia. Cultural and social factors in the Eastern Province may influence patients’ understanding, attitudes, and concerns toward this procedure. Therefore, this study aims to address this gap by evaluating preoperative knowledge and perception among this specific population. 4- more detailed information regarding the sample size estimation Response: thank you for your time and comments Please find the following corrected changes for sample size calculation: The minimum required sample size for this study was calculated using the standard formula for estimating proportions, assuming a 95% confidence level (Z = 1.96), 5% margin of error (d = 0.05), and a conservative estimated proportion (p = 0.50) to maximize population variability. This yielded a required sample size of 384 participants. To ensure adequate representation and account for possible refusals or incomplete responses, the questionnaire was distributed to 420 potential participants, allowing sufficient coverage of the calculated sample requirement. 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility Response: thank you for your time and comments, please find the questionnaire cited at the end of the references as well as the collected data as per the journal criteria 6- the timetable for the study should be mentioned Response: thank you for your time and comments, Ethical approval obtained on October 22, 2022. Data collection was carried out over the following months, followed by data analysis and manuscript preparation until the end of January 12,2024. 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specify what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery? Response: thank you for your time and comments, yes it means that with no previous experience of third molar extraction. 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? Response: thank you for your time and comments, the procedure was explained in simple terms to ensure that all patients—those requiring both simple and surgical (flap) extractions—understood the scope of the questions. The items focused on preoperative awareness, perceived risks, and postoperative expectations, rather than specific surgical techniques, to ensure accurate and comparable assessment of knowledge across all participants. 9- the conclusions should be re-written according to the statistical results of the study Response: thank you for your time and comments, please find the following modified rewritten conclusion: The most common indication for extraction was the abnormal path of tooth eruption, followed by pain or tooth decay. Comparison between patients with and without previous extraction experience revealed generally similar levels of knowledge and perception regarding third molar extraction. However, patients with prior experience demonstrated better understanding of preoperative medication, whereas those without prior experience showed greater awareness of the correct timing of third molar eruption. Misconceptions related to anesthesia and the number of teeth extracted remained common in both groups. Overall, the findings highlight the need for improved patient education on procedural and medication aspects of third molar extraction to enhance understanding and reduce misconceptions. We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") Response: thank you for your time and comments, title adjusted to be: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discusses only preoperative perception. try to focus on the introduction about the value of previous studies and avoid dedicating too much space to a single study Response: thank you for your time and comments Please find the following changes as we removed the extra details and further unnecessary information: Brasileiro B. et al. evaluated patients’ perceptions at different stages of third molar extraction and highlighted notable preoperative concerns regarding the procedure. 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. Response: thank you for your time and comments Please find the following modified rational: Although several studies have examined patients’ perceptions toward third molar extraction in different countries, limited research has focused on the preoperative perceptions of patients in Saudi Arabia. Cultural and social factors in the Eastern Province may influence patients’ understanding, attitudes, and concerns toward this procedure. Therefore, this study aims to address this gap by evaluating preoperative knowledge and perception among this specific population. 4- more detailed information regarding the sample size estimation Response: thank you for your time and comments Please find the following corrected changes for sample size calculation: The minimum required sample size for this study was calculated using the standard formula for estimating proportions, assuming a 95% confidence level (Z = 1.96), 5% margin of error (d = 0.05), and a conservative estimated proportion (p = 0.50) to maximize population variability. This yielded a required sample size of 384 participants. To ensure adequate representation and account for possible refusals or incomplete responses, the questionnaire was distributed to 420 potential participants, allowing sufficient coverage of the calculated sample requirement. 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility Response: thank you for your time and comments, please find the questionnaire cited at the end of the references as well as the collected data as per the journal criteria 6- the timetable for the study should be mentioned Response: thank you for your time and comments, Ethical approval obtained on October 22, 2022. Data collection was carried out over the following months, followed by data analysis and manuscript preparation until the end of January 12,2024. 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specify what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery? Response: thank you for your time and comments, yes it means that with no previous experience of third molar extraction. 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? Response: thank you for your time and comments, the procedure was explained in simple terms to ensure that all patients—those requiring both simple and surgical (flap) extractions—understood the scope of the questions. The items focused on preoperative awareness, perceived risks, and postoperative expectations, rather than specific surgical techniques, to ensure accurate and comparable assessment of knowledge across all participants. 9- the conclusions should be re-written according to the statistical results of the study Response: thank you for your time and comments, please find the following modified rewritten conclusion: The most common indication for extraction was the abnormal path of tooth eruption, followed by pain or tooth decay. Comparison between patients with and without previous extraction experience revealed generally similar levels of knowledge and perception regarding third molar extraction. However, patients with prior experience demonstrated better understanding of preoperative medication, whereas those without prior experience showed greater awareness of the correct timing of third molar eruption. Misconceptions related to anesthesia and the number of teeth extracted remained common in both groups. Overall, the findings highlight the need for improved patient education on procedural and medication aspects of third molar extraction to enhance understanding and reduce misconceptions. Competing Interests: The authors declare no competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 24 Nov 2025 Turki Alshehri , Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia 24 Nov 2025 Author Response We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this ... Continue reading We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") Response: thank you for your time and comments, title adjusted to be: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discusses only preoperative perception. try to focus on the introduction about the value of previous studies and avoid dedicating too much space to a single study Response: thank you for your time and comments Please find the following changes as we removed the extra details and further unnecessary information: Brasileiro B. et al. evaluated patients’ perceptions at different stages of third molar extraction and highlighted notable preoperative concerns regarding the procedure. 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. Response: thank you for your time and comments Please find the following modified rational: Although several studies have examined patients’ perceptions toward third molar extraction in different countries, limited research has focused on the preoperative perceptions of patients in Saudi Arabia. Cultural and social factors in the Eastern Province may influence patients’ understanding, attitudes, and concerns toward this procedure. Therefore, this study aims to address this gap by evaluating preoperative knowledge and perception among this specific population. 4- more detailed information regarding the sample size estimation Response: thank you for your time and comments Please find the following corrected changes for sample size calculation: The minimum required sample size for this study was calculated using the standard formula for estimating proportions, assuming a 95% confidence level (Z = 1.96), 5% margin of error (d = 0.05), and a conservative estimated proportion (p = 0.50) to maximize population variability. This yielded a required sample size of 384 participants. To ensure adequate representation and account for possible refusals or incomplete responses, the questionnaire was distributed to 420 potential participants, allowing sufficient coverage of the calculated sample requirement. 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility Response: thank you for your time and comments, please find the questionnaire cited at the end of the references as well as the collected data as per the journal criteria 6- the timetable for the study should be mentioned Response: thank you for your time and comments, Ethical approval obtained on October 22, 2022. Data collection was carried out over the following months, followed by data analysis and manuscript preparation until the end of January 12,2024. 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specify what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery? Response: thank you for your time and comments, yes it means that with no previous experience of third molar extraction. 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? Response: thank you for your time and comments, the procedure was explained in simple terms to ensure that all patients—those requiring both simple and surgical (flap) extractions—understood the scope of the questions. The items focused on preoperative awareness, perceived risks, and postoperative expectations, rather than specific surgical techniques, to ensure accurate and comparable assessment of knowledge across all participants. 9- the conclusions should be re-written according to the statistical results of the study Response: thank you for your time and comments, please find the following modified rewritten conclusion: The most common indication for extraction was the abnormal path of tooth eruption, followed by pain or tooth decay. Comparison between patients with and without previous extraction experience revealed generally similar levels of knowledge and perception regarding third molar extraction. However, patients with prior experience demonstrated better understanding of preoperative medication, whereas those without prior experience showed greater awareness of the correct timing of third molar eruption. Misconceptions related to anesthesia and the number of teeth extracted remained common in both groups. Overall, the findings highlight the need for improved patient education on procedural and medication aspects of third molar extraction to enhance understanding and reduce misconceptions. We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") Response: thank you for your time and comments, title adjusted to be: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discusses only preoperative perception. try to focus on the introduction about the value of previous studies and avoid dedicating too much space to a single study Response: thank you for your time and comments Please find the following changes as we removed the extra details and further unnecessary information: Brasileiro B. et al. evaluated patients’ perceptions at different stages of third molar extraction and highlighted notable preoperative concerns regarding the procedure. 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. Response: thank you for your time and comments Please find the following modified rational: Although several studies have examined patients’ perceptions toward third molar extraction in different countries, limited research has focused on the preoperative perceptions of patients in Saudi Arabia. Cultural and social factors in the Eastern Province may influence patients’ understanding, attitudes, and concerns toward this procedure. Therefore, this study aims to address this gap by evaluating preoperative knowledge and perception among this specific population. 4- more detailed information regarding the sample size estimation Response: thank you for your time and comments Please find the following corrected changes for sample size calculation: The minimum required sample size for this study was calculated using the standard formula for estimating proportions, assuming a 95% confidence level (Z = 1.96), 5% margin of error (d = 0.05), and a conservative estimated proportion (p = 0.50) to maximize population variability. This yielded a required sample size of 384 participants. To ensure adequate representation and account for possible refusals or incomplete responses, the questionnaire was distributed to 420 potential participants, allowing sufficient coverage of the calculated sample requirement. 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility Response: thank you for your time and comments, please find the questionnaire cited at the end of the references as well as the collected data as per the journal criteria 6- the timetable for the study should be mentioned Response: thank you for your time and comments, Ethical approval obtained on October 22, 2022. Data collection was carried out over the following months, followed by data analysis and manuscript preparation until the end of January 12,2024. 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specify what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery? Response: thank you for your time and comments, yes it means that with no previous experience of third molar extraction. 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? Response: thank you for your time and comments, the procedure was explained in simple terms to ensure that all patients—those requiring both simple and surgical (flap) extractions—understood the scope of the questions. The items focused on preoperative awareness, perceived risks, and postoperative expectations, rather than specific surgical techniques, to ensure accurate and comparable assessment of knowledge across all participants. 9- the conclusions should be re-written according to the statistical results of the study Response: thank you for your time and comments, please find the following modified rewritten conclusion: The most common indication for extraction was the abnormal path of tooth eruption, followed by pain or tooth decay. Comparison between patients with and without previous extraction experience revealed generally similar levels of knowledge and perception regarding third molar extraction. However, patients with prior experience demonstrated better understanding of preoperative medication, whereas those without prior experience showed greater awareness of the correct timing of third molar eruption. Misconceptions related to anesthesia and the number of teeth extracted remained common in both groups. Overall, the findings highlight the need for improved patient education on procedural and medication aspects of third molar extraction to enhance understanding and reduce misconceptions. Competing Interests: The authors declare no competing interests Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 18 Nov 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 11 Nov 25 read Version 1 18 Nov 24 read Ahmed Fadhel Al-Quisi , University of Baghdad, Baghdad, Iraq Brender Leonan-Silva , Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Leonan-Silva B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Nov 2025 | for Version 2 Brender Leonan-Silva , Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil 0 Views copyright © 2025 Leonan-Silva B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, Thank you for the opportunity to review this manuscript. After a detailed evaluation of all sections (Abstract, Introduction, Methods, Results, Discussion, and Conclusion), I regret to note that the study presents substantial methodological, structural, and conceptual limitations that significantly compromise its scientific clarity and validity. Below is a consolidated and detailed report outlining the key issues and recommendations. 1. Major Issues Across the Entire Manuscript 1.1. Lack of a Clear and Coherent Study Objective Throughout the manuscript, the objective remains vague and inconsistently stated. The abstract claims the study is evaluating “knowledge” of third molar extraction. The introduction suggests the aim is to evaluate “preoperative knowledge and perception.” However, the statistical approach and group comparisons indicate the actual aim was likely: “to determine whether previous experience with third molar extraction influences patient knowledge and perceptions.” This objective is never clearly articulated. Recommendation: Rewrite the objective to explicitly match the study design and statistical analysis. 1.2. Severe Inconsistency in Terminology The manuscript alternates between “third molar extraction” and “wisdom tooth extraction” without rationale or consistency. Recommendation: Choose one term and use it consistently throughout the manuscript, tables, and figures. 2. Abstract – Major Structural and Conceptual Problems The abstract lacks a clear objective. The methodology description is vague and incomplete. The results paragraph is grammatically incorrect and difficult to understand. The conclusion is ambiguous and unsupported by the results. Recommendation: Rewrite the abstract entirely to clearly present: Objective Methods (design, participants, outcome variables) Main results Conclusion aligned with the findings 3. Introduction – Problems with Logic, Flow, and Relevance The introduction: Presents excessive background unrelated to knowledge/perception (e.g., surgical difficulty, indications, postoperative pain, QOL studies). Contains paragraphs that do not link to the study’s aim. Does not introduce the constructs being evaluated (knowledge or perception). Does not provide rationale for comparing “previous experience vs. no previous experience.” Recommendation: Rebuild the introduction to: Define knowledge/perception in this context. Present relevant literature on patient awareness regarding third molar procedures. Justify why prior extraction experience might impact knowledge. End with a clear, specific objective. 4. Methods – Major Methodological Weaknesses 4.1. Study Population Ambiguity The sample includes all patients attending the dental hospital for “different dental treatments,” not preoperative third molar patients. This undermines the whole premise of assessing “preoperative” knowledge. 4.2. Sampling Strategy The sample size calculation is inappropriate. A formula for estimating a proportion was used, but the analysis compares two groups. 4.3. Questionnaire Validation The questionnaire is claimed to be “validated” but: No source is given. No psychometric data is reported. No reliability metrics (Cronbach’s alpha). A pilot with 30 patients is not validation. 4.4. Variable Definition “Knowledge” and “perception” constructs are not defined conceptually. All items are simply treated as binary correct/incorrect, which oversimplifies complex constructs. 4.5. Statistical Analysis Issues Logistic regression appears unadjusted (despite collecting age, sex, education). No justification for dichotomization of items. No composite scores. No mention of model diagnostics or assumptions. 5. Results – Numerous Structural and Analytical Problems 5.1. Missing clarity on sample The results start with “409 patients had third molar extractions,” but the Methods say patients were attending “for different treatments.” Inconsistency in sample definition. 5.2. Tables are incomplete and poorly formatted Table 1 has truncated categories. Table 2 presents isolated percentages without meaningful interpretation. Table 3 shows perception questions with unclear scoring logic. 5.3. Figures contain no captions explaining content or methods 5.4. Interpretation Misalignment The results do not justify the emphasis placed in the Discussion. Most findings show no statistically significant differences, but are presented as clinically meaningful. 6. Discussion – Conceptually Weak and Poorly Connected to Results The discussion over-relies on citations unrelated to the study's main variables. It restates background literature instead of critically interpreting results. Many cited findings do not logically relate to the observed results. The claimed “agreement” with prior studies is overstated given weak and mostly non-significant results. The discussion fails to address the possibility that the questionnaire may not have measured the intended constructs. 7. Conclusion – Not Supported by the Data The conclusion states that: “Patients with previous experience demonstrated better understanding…” However: Most comparisons were not statistically significant. The findings were minimal and inconsistent. The conclusion overstates the results. 8. Additional Issues English grammar requires extensive revision throughout the manuscript. Figures appear low quality and lack methodological explanations. The demographic table does not include total sample numbers or proper formatting. The manuscript lacks coherence in structure, terminology, and argumentation. Overall Recommendation: Major Revision Required In its current form, the manuscript requires substantial restructuring before it can be considered for publication. Key required actions: Rewrite the abstract, introduction, and objective. Clarify and fix methodological inconsistencies. Rebuild the Results section with proper formatting and coherent interpretation. Rework the discussion to reflect the study’s actual findings. Ensure consistent terminology and grammar throughout. Provide transparent details about questionnaire development and validation. Consider whether the study design appropriately matches the stated aim — and revise accordingly. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise EpidemiologySystematic Reviews and Meta-analysesEvidence Synthesis (Scoping Reviews, Narrative Reviews)Clinical Trials (randomized, non-randomized, split-mouth, crossover, non-inferiority)Observational Study Designs (cross-sectional, cohort, case-control)Interventional StudiesPeriodontologyTemporomandibular Disorders (TMD)BruxismOrofacial PainDental Public Health I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Leonan-Silva B. Peer Review Report For: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.5256/f1000research.191114.r434493) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1376/v2#referee-response-434493 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Al-Quisi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Jan 2025 | for Version 1 Ahmed Fadhel Al-Quisi , Oral and Maxillofacial Surgery, University of Baghdad, Baghdad, Baghdad Governorate, Iraq 0 Views copyright © 2025 Al-Quisi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In scientific writing, terms like "us," "our," and "we" are considered first-person pronouns and should be avoided in scientific writing 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discuss only preoperative perception. try to focus in the introduction about the value of prevoius studies and Avoid dedicating too much space to a single study 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. 4- more detailed information regarding the sample size estimation 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility 6- the time table for the study should be mentioned 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specifiy what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery ? 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? 9- the conclusions should be re-written according to the statisitcal results of the study Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Oral and Maxillofacial Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 24 Nov 2025 Turki Alshehri, Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia, Saudi Arabia We sincerely thank the reviewer for their valuable time, constructive comments, and insightful suggestions, which have greatly improved the quality of our manuscript. 1-the title should clearly reflect this to inform readers about the timing of knowledge evaluation. Titles for such studies typically include phrases that highlight the timing (e.g., "prior to," "pre-extraction") Response: thank you for your time and comments, title adjusted to be: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study 2- the 6th paragraph of the introduction provides detailed information about Brasileiro B. et al.'s study who assessed patients’ preoperative, intraoperative, and postoperative perception while the current study discusses only preoperative perception. try to focus on the introduction about the value of previous studies and avoid dedicating too much space to a single study Response: thank you for your time and comments Please find the following changes as we removed the extra details and further unnecessary information: Brasileiro B. et al. evaluated patients’ perceptions at different stages of third molar extraction and highlighted notable preoperative concerns regarding the procedure. 3- re-write of the rationale focusing on the gap in the literature and detailing the unique factors of the specific ethnic group the study investigated. Response: thank you for your time and comments Please find the following modified rational: Although several studies have examined patients’ perceptions toward third molar extraction in different countries, limited research has focused on the preoperative perceptions of patients in Saudi Arabia. Cultural and social factors in the Eastern Province may influence patients’ understanding, attitudes, and concerns toward this procedure. Therefore, this study aims to address this gap by evaluating preoperative knowledge and perception among this specific population. 4- more detailed information regarding the sample size estimation Response: thank you for your time and comments Please find the following corrected changes for sample size calculation: The minimum required sample size for this study was calculated using the standard formula for estimating proportions, assuming a 95% confidence level (Z = 1.96), 5% margin of error (d = 0.05), and a conservative estimated proportion (p = 0.50) to maximize population variability. This yielded a required sample size of 384 participants. To ensure adequate representation and account for possible refusals or incomplete responses, the questionnaire was distributed to 420 potential participants, allowing sufficient coverage of the calculated sample requirement. 5- Including a copy of the questionnaire in the study is highly recommended for transparency and reproducibility Response: thank you for your time and comments, please find the questionnaire cited at the end of the references as well as the collected data as per the journal criteria 6- the timetable for the study should be mentioned Response: thank you for your time and comments, Ethical approval obtained on October 22, 2022. Data collection was carried out over the following months, followed by data analysis and manuscript preparation until the end of January 12,2024. 7- the author mentioned (45% had previous wisdom tooth extraction experience, whereas 55% had no previous dental surgical expertise.) please specify what is the no previous dental surgical expertise. did you mean no previous lower third molar surgery? Response: thank you for your time and comments, yes it means that with no previous experience of third molar extraction. 8-- how authors ensure accurate assessment of patient knowledge regarding wisdom tooth extraction, particularly for those requiring only simple extractions without flap reflection? Response: thank you for your time and comments, the procedure was explained in simple terms to ensure that all patients—those requiring both simple and surgical (flap) extractions—understood the scope of the questions. The items focused on preoperative awareness, perceived risks, and postoperative expectations, rather than specific surgical techniques, to ensure accurate and comparable assessment of knowledge across all participants. 9- the conclusions should be re-written according to the statistical results of the study Response: thank you for your time and comments, please find the following modified rewritten conclusion: The most common indication for extraction was the abnormal path of tooth eruption, followed by pain or tooth decay. Comparison between patients with and without previous extraction experience revealed generally similar levels of knowledge and perception regarding third molar extraction. However, patients with prior experience demonstrated better understanding of preoperative medication, whereas those without prior experience showed greater awareness of the correct timing of third molar eruption. Misconceptions related to anesthesia and the number of teeth extracted remained common in both groups. Overall, the findings highlight the need for improved patient education on procedural and medication aspects of third molar extraction to enhance understanding and reduce misconceptions. View more View less Competing Interests The authors declare no competing interests reply Respond Report a concern Al-Quisi AF. Peer Review Report For: Evaluation of Pre-Extraction Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study [version 2; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :1376 ( https://doi.org/10.5256/f1000research.173698.r350574) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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